Gastrointestinal

GERD (Gastro-Oesophageal Reflux Disease)

سینے کی جلن

Burning chest pain worse on leaning forward or after food, with excessive salivation and hiccups. Always be vigilant about chest pain and rule out a cardiac cause.

ICD-10: —
Source: OPD handbook pp.44–47, 50
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Burning chest pain, worse by leaning forward and by food intake
Excessive salivation
Hiccups

Red flags Refer urgently if any are present

Compressing chest pain
Cold peripheries
Known case of DM, HTN or IHD: rule out a cardiac cause

Diagnosis

Examination is unremarkable

Treatment

Step 1 of 4

1. Counselling

Cut down tea, oily and fried foods and bakery items
Take dinner two hours before sleeping
Do not lie on the bed straight after eating
Increase fruit and vegetables
Take curd (dahi) in the breakfast
Make a habit of eating salad

Step 2 of 4

2. Prokinetics

Prescription

MetoclopramideProkinetic / antiemetic

Dose10 mg TDS (1+1+1)

Brand Tab Maxolone 10 mg

Also sold as Maxolone, Maxolon, Metaclon, Metomide

MetoclopramideProkinetic / antiemetic

Dose2 tsf, 2+2+2 (morning, noon, evening)

Brand Syp Maxolone 5 mg/5 mL

Also sold as Maxolone, Maxolon, Metaclon, Metomide

DomperidoneProkinetic / antiemetic

Dose10 mg TDS (1+1+1), before meals

Brand Stomacol / Motilium

Also sold as Stomacol, Motilium, Peridone

Step 3 of 4

3. Antacids

Dose: 2 teaspoons TDS, half an hour after meals

Prescription

Antacid suspension (Dijex MP / Gaviscon Advance / Lagita Advance)Antacid / alginate

Dose2 tsf TDS after meals

Brand Syp Dijex MP / Gaviscon Advance / Lagita Advance

Also sold as Dijex MP, Gaviscon Advance, Lagita Advance (as written), Mucaine

Step 4 of 4

4. Proton pump inhibitors

In GERD the sachet form is preferred, e.g. Ruling sachet 40 mg 1+0, half an hour before breakfast
Dexlansoprazole is the safest in GERD and pregnancy

Prescription

OmeprazoleProton pump inhibitor

Dose40 mg OD

Brand Ruling / Risek / Teph / Sante

Also sold as Risek, Teph, Ruling, Ruling sachet, Omega

Ruling sachet 40 mg, 1+0 before breakfast

EsomeprazoleProton pump inhibitor

Dose40 mg OD

Brand Eskem / Novoteph / Esante

Also sold as Novoteph, Esante, Eskem, Eswin, Nexum, Esso, Exium

DexlansoprazoleProton pump inhibitor

Dose30 mg OD

Brand Dexo / Delanzo DR

Also sold as Dexo, Delanzo DR

Safest in GERD and pregnancy

Sample prescription from the book (patient details removed)

Male, 33 y, banker, burning chest pain on and off, increased with heavy meals; examination unremarkable: Ruling sachet 40 mg 1+0 before breakfast; Tab Stomacol 10 mg 1+1+1 before meals; Syp Dijex MP 2+2+2 after meals; avoid tea, oily and fried things; dinner two hours before sleeping; do not lie down straight after eating; light exercise; more fruit, vegetables and curd.